Dr. Ofafa is a registered nurse with over a decade of experience in improving nurse retention, implementing competency-based nursing workforce solutions, and improving healthcare quality. She is passionate about empowering nurses at the point of care and is a huge advocate for diversity and equity in nursing. Karen serves as the Director of Transition to Practice for the Arizona Hospital and Healthcare Association (AzHHA) where she is responsible for providing direction and oversight of the design, development, implementation, and evaluation of the Arizona Statewide Transition to Practice Program for newly licensed Registered Nurses.
Dr. Ofafa completed her Doctor of Education in Leadership and Learning with a specialization in Health Care Administration and Leadership program at Aspen in October of 2024. She also holds a Master of Public Health Degree from Walden University and is a Certified Health Care Quality Professional and a Certified Six Sigma Black Belt. She presented her project during Aspen’s 2024 Fall Research Colloquium and the video recording can be found here.
I am excited to share my dissertation with the Aspen community. It is titled: Understanding the Nursing School Admission Process from the Perspective of Minority Students and Administrators. My focus was on understanding the lack of diversity in nursing.
I was born in Kenya but have resided in the United States for most of my adult life. As a minority I have had my fair share of challenges when it comes to navigating the education and healthcare systems in the US. I have always been an advocate for my own journey but have seen huge disparities in minorities and specifically immigrants trying to make it in the US. I also have elderly parents who have navigated the healthcare system here and I have noticed gaps in their care as a result of them not receiving care from culturally competent healthcare providers. One area I struggle with is when assumptions are made of minorities even when the minority patient can communicate effectively and take part in their care. I have been on a quest to affect change and policies regarding increasing minorities in nursing and the need for culturally competent care.
The United States continues to witness a profound transformation in its demographic landscape and consequently becoming more diverse each subsequent year. We are seeing an increase in minorities in areas that were predominantly inhabited by white people (U.S. Census Bureau, n.d.). This shift in demographics has implications, particularly in healthcare. When it comes to healthcare, patients tend to build trust with caregivers they can relate to or providers who share the same cultural background (Saha et al., 2007). Consequently, the nursing workforce needs to diversify to be able to provide culturally competent care. A diverse nursing workforce, which means a workforce representative of the patient population, is essential to care for patients with varied backgrounds (IOM, 2016). Thus, diversity in nursing has been a hot topic and a priority for the healthcare workforce for decades. Specifically, the nursing shortage and lack of minority representation in nursing are two problems that are well documented in nursing literature (AACN, 2022).
This lack of diversity in nursing continues to have implications on the quality of care and health outcomes (AACN, 2022; DeCoux Hampton et al. 2022).
Significant health disparities persist among racial and ethnic minorities. We have seen even with Covid that mortality was more evident in minorities. This is partly because navigating healthcare in the US is difficult for the average person and even more complex for minorities and immigrant patients. Therefore, the lack of diversity in nursing has been linked to poor health outcomes and increased health disparities among racially diverse patients. Health outcomes are improved when there is a connection between the patient and their healthcare providers. Patients want to be cared for by a provider who can understand them. It is also important to note that nurses tend to practice in the communities they live in. Therefore, if the number of minority nurses increases, the community’s overall quality of care will also improve.
To address challenges posed by the lack of diversity in nursing and to provide culturally competent care, a diverse nursing workforce is needed. Consequently, understanding the lack of diversity in nursing is imperative and critical to increasing the number of minorities in nursing. To understand the depth of this issue, researchers must understand the barriers experienced by minority nursing students in relation to the nursing school admission process. Additionally, researchers must understand the perception of minority nursing students and their administrators on nursing school recruitment.
The lack of minorities in nursing could stem from the recruitment and admission process. With this knowledge, the population of interest for this study was minority nursing students who are in their core nursing program and their administrators. To increase the number of minority nursing students, the minority nursing students’ perspectives on recruitment and admission process need to be examined. This research aimed to explore the nursing school admission process from the perspective of minority nursing students and their administrators. The study aimed to answer three research questions:
What are the perceptions of minority nursing students in the Southwestern United States regarding their admission process?
What are the perceived barriers to admitting minority nursing student applicants identified by nursing school administrators in the Southwestern United States?
What actions have the nursing schools in the the Southwestern United States implemented to increase minorities in their nursing programs?
Based on a review of literature, there is a deficit in the knowledge regarding the current minority nursing student’s experiences regarding their application and admission experiences (Loftin et al., 2012; Noone & Najjar, 2021; Zimnicki et al., 2022). This study aimed to address that gap by providing knowledge on the perceptions of the nursing admission process from the perspective of minority nursing students and their administrators. The study findings revealed barriers and perceptions shared by the minority study participants. The barriers described by the participants included financial constraints, issues with nursing admission waiting periods, issues with the admission process itself, challenges brought on by a diverse identity, complexities of being an immigrant, issues with the admission priority, challenges with the prerequisites and insufficient support received with the admission process. Understanding these findings is crucial in order to support minorities in nursing. These issues were also backed by the nursing school administrators in the study. Publishing and disseminating these study findings will be pivotal in guiding the nursing community to develop and implement strategies to increase minorities in nursing.
In sharing my publication and my story, I hope to impact equity in nursing.
References
American Association of Colleges of Nursing. (2022, September). Enhancing-diversity-factsheet [PDF]. Retrieved September 24, 2021, from https://www.aacnnursing.org/Portals/42/News/Factsheets/Enhancing-Diversity-Factsheet.pdf
DeCoux Hampton, M., Dawkins, D., Rickman Patrick, S., Onglengco, R., Stobbe, B., Kaufman, S., Alexa Hampton, C., & Palazzo, C. (2022). Holistic admissions review integration in nursing programs. Journal of Nursing Education, 61(7), 361–366. https://doi.org/10.3928/01484834-20220610-01
Institute of Medicine. (2016, April 7). Iom-diversity-recommendations3 [PDF]. https://campaignforaction.org/wp-content/uploads/2016/04/IOM-Diversity-Recommendations3.pdf. https://campaignforaction.org/wp-content/uploads/2016/04/IOM-Diversity-Recommendations3.pdf
Loftin, C., Newman, S. D., Dumas, B. P., Gilden, G., & Bond, M. (2012). Perceived barriers to success for minority nursing students: An integrative review. ISRN Nursing, 2012, 1–9. https://doi.org/10.5402/2012/806543
Noone, J., & Najjar, R. (2021). Minimizing unconscious bias in nursing school admission. Journal of Nursing Education, 60(6), 317–323. https://doi.org/10.3928/01484834-20210520-03
Saha, S., Fernandez, A., & Perez-Stable, E. (2007). Reducing language barriers and racial/ethnic disparities in health care: An investment in our future. Journal of General Internal Medicine, 22(S2), 371–372. https://doi.org/10.1007/s11606-007-0372-4
United States Census Bureau. (n.d.). Explore census data. United Census Bureau. https://data.census.gov/table?g=010XX00US%26d=DEC%20Demographic%20Profile
Zimnicki, K. M., Aaron, K. S., McQuillen, E. P., Palma, A. L., Sikora, G. V., & Carter, E. V. (2022). When holistic admissions review is not enough: Barriers to diversity. Journal of Nursing Education, 61(7), 375–382. https://doi.org/10.3928/01484834-20220610-03